USA
Fax 855.676.9280
pcsupport@lifevantage.com
PREFERRED CUSTOMER APPLICATION
Preferred Customer Information *Required Information (Please Print Clearly)
Co-Applicant (if applicable)
*First Name and Last Name
*First and Last Name (Legal Name)
*Gender
F
M
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-
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*Birth Date (MM/DD/YYYY) (Co-Applicant must be 18 years or older)
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*Birth Date (MM/DD/YYYY) (Co-Applicant must be 18 years or older)
Preferred Customer Contact Information
(
)
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*Home Phone
(
)
Fax Number
(
)
-
Cell Phone
-
By signing and submitting this Application, I agree that LifeVantage or a party acting on its behalf may contact me by telephone using automated technology (e.g.,
an auto-dialer or pre-recorded messaging), text messaging or email. I consent and
agree to LifeVantage contacting me in this manner at the telephone number(s) or
email address that I provided above and as updated. I understand that my carrier’s
standard rates will apply for calls and text messages. I may opt-out from receiving
text messages at any time by replying “STOP”. I understand that my consent is
not a condition of purchase. I consent and agree to the LifeVantage privacy policy
when I sign and submit this Preferred Customer Agreement.
*Applicant E-mail
Preferred Customer Billing Address
Preferred Customer Shipping Address (Leave blank if same as billing address)
*Address
*Address
*City
* State
*Zip Code
*City
*State
*Zip Code
Enroller Information (Your enroller is the individual who introduced you to LifeVantage.)
Placement Sponsor Information (Your placement indicates the individual under whom
Enroller Name
Placement Sponsor Name
ID Number
you are placed. If no one is listed, your enroller also becomes your Placement Sponsor. Your enroller is
able to place you within 30 days.)
©2016 LifeVantage Corporation • 9785 S. Monroe St., Ste. 300, Sandy, UT 84070 • USA • 877.972.5546 • lifevantage.com
This form may not be altered without the express written consent of LifeVantage.
ID Number
16030301.07 PAGE 1 OF 3
Revised 07/22/2016
USA
Fax 855.676.9280
pcsupport@lifevantage.com
PREFERRED CUSTOMER APPLICATION
PRODUCT
PRICE
INITIAL ORDER
Qty
.
Protandim® Nrf2
$40
Protandim® NRF1
$49
Protandim® DUO Pack
$85
Protandim® Sample (10-pk)
$30
TrueScience™ Skin Care Regimen (includes the below 4 products)
Sub-Total
AUTOSHIP
Qty
.
Sub-Total
$160
• TrueScience™ Ultra Gentle Facial Cleanser
$25
• TrueScience™ Perfecting Lotion
$40
• TrueScience™ Eye Corrector Serum
$40
• TrueScience™ Anti-Aging Cream
$70
TrueScience™ Anti-Aging Cream Sample (10-pk)
$30
TrueScience™ Micro Lift Serum
$50
AXIO® Dragon Fruit
$50
AXIO® Green Grape
$50
AXIO® Decaf Red Raspberry
$50
AXIO® Decaf Grapefruit
$50
AXIO® Sour Cherry
$50
LifeVantage® Canine Health
$25
PhysIQ™ ProBio
$40
PhysIQ™ Fat Burn
$45
PhysIQ™ Protein
$55
PhysIQ™ Cleanse
$15
PhysIQ™ Single System with Cleanse
$140
PhysIQ™ Double System with Cleanse
$270
PhysIQ™ Single System
$130
PhysIQ™ Double System
$260
Shipping, handling and applicable sales tax will be added to each order.
TOTAL
TOTAL
Please Note: Prices and products are subject to change.
Monthly Autoship Date
5th
10th
15th
20th
25th
(Please select your monthly Autoship date. Your Autoship will begin on the month following your initial order and will ship on the date you select each month thereafter.)
Payment Information
In an effort to protect your credit card information, we request that you do not write it on this form. Please provide a phone number where you can be
reached, and indicate your preferred time of day for a customer support representative to call you to process your payment.
(
)
-
Best time to reach me:
morning
afternoon
evening
Phone
©2016 LifeVantage Corporation • 9785 S. Monroe St., Ste. 300, Sandy, UT 84070 • USA • 877.972.5546 • lifevantage.com
This form may not be altered without the express written consent of LifeVantage.
16030301.07 PAGE 2 OF 3
Revised 07/22/2016
PREFERRED CUSTOMER AGREEMENT TERMS AND CONDITIONS
1. This document is your application to become a Preferred Customer of LifeVantage Corporation (referred to as “LifeVantage” or the “Company”). When submitted by you and accepted by LifeVantage,
this document is an agreement between you and LifeVantage.
2. I agree that membership entitles me to purchase product at wholesale prices for personal consumption and I may not sell, resell or distribute product. This obligation will continue even after my
agreement is cancelled. If I wish to distribute product, I will join as an Independent Distributor and I understand that LifeVantage would not sell to me otherwise. I agree and understand product
purchased must be consumed in the USA or an approved Not For Resale market and I must maintain a monthly Autoship order.
3. I understand that only one LifeVantage Preferred Customer or Independent Distributor account is allowed per person and only two per immediate household. Individuals of the same family unit
may not enter into or have an interest in more than two LifeVantage accounts. A “family unit” is defined as spouses (as further defined below) and dependent children living at or doing business at the
same address.
4. I understand husbands and wives or common-law couples (collectively “Spouse(s)”) who wish to have separate accounts must sign a separate agreement, and must have the same enroller. Any
violation of this provision may result in the termination of my account and disciplinary action against both accounts.
5. Preferred Customer Referral Program. Preferred Customers may participate in the Preferred Customer Referral Program and may qualify for a credit(s) that may be used toward the purchase of future
product. If a Preferred Customer account is canceled, any referral credit(s) will be forfeited. Additional details may be found at www.lifevantage.com. LifeVantage reserves the right to change or discontinue
the Preferred Customer Referral Program without notice at any time.
6. Once enrolled, I understand I may not change my Enroller or Placement Sponsor other than as allowed within the Placement Sponsor Change guidelines. If I decide to upgrade my account to become
an Independent Distributor, I will submit a hard copy Independent Distributor Application to the company or upgrade through my Virtual Office login. I understand I will maintain the same ID number and
genealogy position under my Enroller and Placement Sponsor.
7. As a Preferred Customer, I may change Marketing Organizations by voluntarily cancelling my Preferred Customer account, remaining inactive and not operating any LifeVantage account for six (6) full
calendar months. Following the six (6) month period of cancellation and inactivity, I may reapply under a new Enroller as a Preferred Customer or as an Independent Distributor by submitting a new
application to LifeVantage.
8. As a Preferred Customer, I have the right to cancel my Preferred Customer Agreement at any time. Cancellation must be submitted in writing to LifeVantage at its principal business address: 9785 South
Monroe Street, Suite 300, Sandy, Utah 84070, USA. The written notice must include my signature, printed name, address, and LifeVantage Identification Number.
9. I authorize LifeVantage to submit a charge for payment, from my credit or debit card as provided to LifeVantage, for my monthly Autoship purchase of product that is specifically identified in this
application or as updated. I understand applicable shipping, handling and sales tax will be added to each order.
10. I understand that my first order will be processed and shipped within five (5) calendar days of LifeVantage’s acceptance of my first order. Furthermore, I understand that periodic shipments of
the product that I have ordered will occur without any further action by me. I understand that there will be approximately a one (1) month interval between each shipment. I understand that applicable
shipping, handling and sales taxes will be added to my Autoship order amount each month, based on the address to which my Autoship orders are sent and in accordance with the method of shipping
I have selected or as I may update. I authorize LifeVantage to add such amount to the amount charged to the credit or debit card as provided to LifeVantage.
11. I understand I and/or a recipient of an order must confirm that the product received matches the product listed on the shipping notice and is free of damage. Failure to notify LifeVantage of any
shipping discrepancy or damage within thirty (30) days of shipment waives a Preferred Customer’s right to request a correction.
12. I understand that to change any feature of my Autoship, I must submit a new Autoship Application. Each Autoship Application will supersede all previous
Autoship Applications.
13. I understand that this Autoship Agreement will remain in effect until: (1) I elect to modify it by submitting a new signed Autoship form; (2) I send, in writing, my cancellation of my participation in the Autoship
Program to LifeVantage Corporation Attn: Preferred Customer Support at 9785 South Monroe Street, Suite 300, Sandy, Utah 84070, USA, by faxing 1.855.676.9280, or by calling 1.877.972.5546. I acknowledge
that this cancellation notice must include my signature, printed name, address and my LifeVantage Identification Number; (3) I stop payment withdrawals by LifeVantage by notifying my issuing bank at least three
(3) business days prior to the scheduled charging of my account; or (4) my payment method declines for three (3) consecutive months. Notice of cancellation must be received by LifeVantage at least three
(3) business days prior to the monthly Autoship date; cancellation will become effective in the month following the month in which my notice of cancellation is received by LifeVantage.
14. I understand that I may cancel my Autoship participation within three (3) business days of the date of my submission of this application to LifeVantage and receive a full refund of any Autoship related
amounts charged to my credit or debit card for the initial Autoship order. Thereafter, refunds will be available as provided in accordance with LifeVantage’s policies.
15. Product returned within thirty (30) days after the purchase shall receive a 100% refund, less shipping and handling costs. Only unopened product shall be eligible for a refund, unless defective.
Product must be in resalable and restockable condition in order to be eligible for a refund. Resalable is defined as product still in its original packaging, with seals and wrapping in place. Any
merchandise that is clearly identified at the time of sale as nonreturnable, discontinued, or as a seasonal item, shall not be resalable. All returns must have a Return Merchandise Authorization (“RMA”),
issued through Preferred Customer Support. Customers are responsible for returning product to the LifeVantage within ten (10) business days of issuance of the RMA or the product will not be eligible for
return. Please allow for up to twenty (20) days from the time that the product is received for the refund to be processed. If a shipment is refused, whether it is an Autoship or an order that has just been
placed, LifeVantage will charge a $10.00 shipment refusal fee to the form of payment on file.
16. I consent to the disclosure of my telephone number(s), fax number, and/or e-mail address listed on my application or as updated, and information regarding my purchases from LifeVantage, to
my Enroller, Placement Sponsor and Upline. I agree that LifeVantage or a party acting on its behalf may contact me by telephone using automated technology (e.g., an auto-dialer or pre-recorded
messaging), text messaging or email. I consent and agree to LifeVantage contacting me in this manner at the telephone number(s) or email address that I provided above and as updated. I understand
that my carrier’s standard rates will apply for calls and text messages. I may opt-out from receiving text messages at any time by replying “STOP”. I understand that my consent is not a condition of
purchase. I consent and agree to the LifeVantage privacy policy when I sign and submit this Preferred Customer Agreement.
17. If I have any questions about or believe any errors have been made such as referral credits, my enrollment or placement, the enrollment or placement of my downline, credit card charges, etc., I must
notify LifeVantage in writing within sixty (60) days of the date of the purported error or incident in question. LifeVantage will not be responsible for any errors, omissions or problems not reported to the
Company within sixty (60) days of the purported error or incident in question.
18. Preferred Customer does not have any right to transfer or assign any rights or delegate any duties under the Agreement without the prior written consent of LifeVantage. Any attempt to transfer or assign
the Agreement without the express written consent of LifeVantage is totally ineffective and void and will be a material breach of this Agreement. LifeVantage has the right to transfer or assign any or all of its
rights and to delegate any or all of its duties under the Agreement without the prior written consent of the
Preferred Customer.
19. I understand that LifeVantage may amend this Preferred Customer Agreement. I agree to be bound by all such amendments and that my only remedy for not accepting such amendments is to
immediately terminate this Agreement. My placing an order or accepting an order after publication of any amendment will constitute my acceptance of the amendment.
20. I agree that personal jurisdiction and venue for any dispute arising out of or relating to this Agreement are proper exclusively in the state and federal courts located in the State of Utah, County of
Salt Lake and I hereby submit to, and waive any objection to, personal jurisdiction or venue in such courts for such purpose.
By signing and submitting this form and payment for my Preferred Customer order, I am applying to become a LifeVantage Preferred Customer. I acknowledge that I have read and agree to the Terms
and Conditions on the front and back of this Agreement.
_____________________________________________________
Applicant Signature
____________________________________________________
Co-Applicant Signature (if applicable)
_____________________________________________________
Printed Name of Applicant
____________________________________________________
Printed Name of Co-Applicant (if applicable)
Date (MM/DD/YYYY)
-
-
-
Date (MM/DD/YYYY)
©2016 LifeVantage Corporation • 9785 S. Monroe St., Ste. 300, Sandy, UT 84070 • USA • 877.972.5546 • lifevantage.com
This form may not be altered without the express written consent of LifeVantage.
16030301.07 PAGE 3 OF 3
Revised 07/22/2016